COMMENTARY

Stuck in the Past: Why Are Doctors Still Using the Stethoscope and Manila Folder?

Michael Splinter Asks Why Physicians Haven't Adopted More Modern Technology

; Michael R. Splinter

Disclosures

December 10, 2013

Editor's Note:
Michael Splinter, Executive Chairman of Applied Materials, one of the largest chip manufacturers in the world, met up with Medscape Editor-in-Chief Dr. Eric Topol at a meeting of the Semiconductor Industry Association on November 7. Mr. Splinter was being recognized as the 2013 recipient of the Robert N. Noyce Award, the semiconductor industry's most prestigious recognition. While there, Mr. Splinter asked Dr. Topol why doctors still use stethoscopes and manila folders. Dr. Topol thought it best that Mr. Splinter address the question in a commentary on Medscape. Below is Mr. Splinter's commentary, followed by Dr. Topol's response.

The Stethoscope

Michael R. Splinter

I have been getting a physical every year for as long as I can remember, most certainly for the past 25 years. Over that period of time I have moved several times and have seen different doctors in different cities. I mark the calendar each year around my birthday as a reminder to schedule my physical. Over these past 25 years, so much new technology has been invented and introduced. The cell phone, the Internet, and email have all become ubiquitous. The smart phone is now a constant companion, and the Cloud presents a virtually infinite ability to store and analyze massive sets of data. During this time the cost of doing a DNA test has also dropped at least 100 times, and now you can send in a swab and get a DNA profile for $100. These are all truly amazing steps forward in technology, and our lives have changed for the better in the way we work and play. The signs are visible in virtually every moment of the day.

Yet when I walk into my doctor's office, it is a time warp -- not back 25 years but more like 200 years. It is what I call the "stethoscope and manila folder syndrome." The stethoscope was invented in 1816, nearly 200 years ago. And while the tubes have transformed from wood to rubber, and sensing plates are now metal, not much else has changed in this pre-Civil War medical instrument. As my granddaughter would say, "Are you kidding me?" Even though we call the stethoscope a scope, it does not scope anything. It simply is a little amplifier analogous to the Edison phonograph or a Victrola -- like the ones you see with big horns in the old-time movies. Sadly, I am not joking. This is a truly archaic device and yet we trust our lives and health to it in a way that is out of touch with the world we live in today. The stethoscope has no ability to record information; it has no ability to analyze information. Its successful usage depends totally on the practitioner at the moment. I wonder how much harm and delay the stethoscope causes these days in missed diagnosis or inaccurate conclusions. Today it is simple to create an electronic stethoscope with far greater capabilities. Start with a microprocessor and then add a microphone -- and microphones are so cheap, you could affordably have 5 microphones and still ensure that outside noise is canceled. If desired, you could still have earplugs to listen, but this is totally unnecessary because the sound could be amplified to a speaker and the patient could actually understand what the physician is hearing. Of course, the information received could be recorded, analyzed, compared over years, and provide a base from which better and more consistent medical conclusions could be drawn.

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